3804 W MUKILTEO BLVD 2019-07-08 - Laserfiche WebLink

F-=CTRICAL PERMIT APPL ,TION CITY OF EVERETT PERMIT SERVICE Imo' y y- 3200 CEDAR STREET, EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 I (E)everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 3804 W Mukilteo Blvd BUILDING AREA: 1100 sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION TENANT IMPROVMENT ❑ REMODEL BUILDING USE: [Li SFR ❑ TOWNHOUSE ❑ DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK:$ 400 ASSOCIATED BUILDING PERMIT#(if applicable): SCRIBE SCOPE OF WORK: ?, Install hot tub disconnect \� THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ✓❑ NO Cl YES-Select Scope: ❑ Service El Feeder El Circuits-#: ❑ Complete Re-wire LOW VOLTAGE WORK? NO ❑YES-#of Devices: SELECT SCOPE (REQUIRED): ❑ Data Cl Intercom E Thermostat E Audio ❑ Secure Access ❑ Security System El Fire Alarm- Installations under this permit only include electrical wiring rough-in of the system.An additional Fire Alarm Permit is required for review of device location and installation approval. ✓❑ Other(List All): Hot tub disconnect CODE COMPLIANCE IS THIS PERMIT EDUCATION, INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: ❑ NO El YES--See Below& Pg. 2 By checking this box, I am stating that I have read and understand all of WAC 296-46B-900,selected the specific reason on page 2 of this application(see next page),AND Plan Review is NOT required because I meet all of the following sub sections that do not See Page 2 require Plan Review. ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: ❑N EYES-See Below&Pg. 3 Pursuant to RCW 19.28.261, property owners and leaseholders cannot perform electrical work on buildings for rent, sale, or lease without the proper electrical licensing and certification, or exemption. By checking this box, I am stating that I have completed and See Page 3 signed the AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement. CONTACT INFORMAT I OWNER NAME: Jean Wieser TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 3804 W Mukilteo Blvd CITY Everett STATE WA ZIP 98203 OWNER PHONE:425442-0421 OWNER EMAIL:jean_WieSer@hotmail.COm CONTRACTOR NAME: Custom Electrical Services LLC CONTRACTOR ADDRESS: STREET 3802 Auburn Way N Ste 307 CITY Auburn STATE WA ZIP 98002 CONTRACTOR PHONE:425-2824971 CONTRACTOR EMAIL:Info@customelectricalseattle.com CONTRACTOR LIC.#(REQUIRED):CUSTOES893J2 CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 53698 PRIMARY CONTACT: DOWNER ✓❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:425-282-4971 Katie Kelly CONTACT EMAIL:info@customelectricalseattle.com AGREEMENT:I hereby certify that l have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be completed whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law regulating construction or the performance of construction. That I am authorized by the owner of this property to perform the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT#:E ` Katie Kelly 3/18/19 \9 Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application